High PSA Predicts Elevated Risk of Lower Urinary Tract Symptoms

LUTS is 49% more likely to develop in men with a PSA level above 6 ng/mL versus 4 ng/mL or less.

SAN DIEGO—Men with mild or no lower urinary tract symptoms (LUTS) but who have PSA levels above 6 ng/mL are at increased risk of developing incident LUTS believed to be secondary to benign prostatic hyperplasia (BPH), investigators reported at the American Urological Association's 2016 annual meeting.

Tom Feng, MD, a urology resident at Cedars-Sinai Medical Center in Los Angeles, and colleagues analyzed data from 3,060 men who participated in the REDUCE [Reduction by Dutasteride of Prostate Cancer Events) trial, a 4-year randomized, placebo-controlled study looking at the effect of dutasteride on the risk of prostate cancer in biopsy-negative men. Of these men, 329 (10.7%) progressed to incident LUTS, defined as the first report of medical treatment, surgery, or sustained clinically significant LUTS (2 reports of an International Prostate Symptom Score greater than 14).

Compared with men who had a baseline PSA level of 4 ng/mL or less, those with a baseline PSA level above 6 ng/mL had a 49% increased risk of incident LUTS in multivariable analysis. A baseline PSA level of 4.1–6.0 ng/mL was associated with a nonsignificant 33% increased risk.

The study population had a mean age of 62 years and was 92.4% white. The median prostate volume was 40.6 cc. Of the 3,060 men, 1,534 (50.1%) were in the placebo arm of the REDUCE trial and 1,526 (49.9%) were in the dutasteride arm.

“BPH poses a significant burden to public health,” Dr. Feng told Renal & Urology News. “Studies have looked at risk factors for development of LUTS, such as increased prostate size. We know that prostate size correlates with PSA, but the relationship of PSA to the development of LUTS in asymptomatic men is unknown. We found that baseline PSA was a significant predictor of incident LUTS. Higher PSA was associated with a greater risk of developing significant LUTS presumed due to BPH. Our study reveals that men with greater PSA, especially greater than 6, are potential candidates for closer follow-up.”